Visual summary Young person Eating disorders can affect men and women

presents to primary
Eating disorders
May present alone or with parent/guardian
care with suspected
eating disorder Parent/guardian may present alone with concerns
Initial assessment in primary care

Take history Developing a therapeutic

relationship is important:
Ask about: Changes in eating Food eaten yesterday Vomiting Exercise
Repeated weighing or body checking Preoccupation with weight and shape Thank you for being
brave enough to tell
Are they trying to lose weight? If so, what would be their ideal weight? Use of diet pills and laxatives me about this

Stopping prescribed medicines Suppressing hunger with caffeine, smoking, or excessive water drinking

Be honest about the limits of confidentiality:

Assess mental health and social functioning
Can we think
together about letting Suicidal ideation/plans Current stressors
your parents know? School Family Peers Abuse
Anxiety Depression

Examine for physiological consequences

General physical appearance Height and weight Skin
May
Signs of malnourishment appear May be less than minimally expected Pressure sores
well Less than 75% weight for height
Check hair and teeth Dehydration Russell’s sign
May be normal or increased
Cardiovascular
Slow pulse Delayed Postural
capillary refill tachycardia Musculoskeletal Gastrointestinal
Back or bone pain
<50 beats/
min Muscle Spinal Tenderness
Decreased core temperature weakness compression
Constipation or ileus
Low blood pressure
Sit/squat Osteoporotic Gastric dilation
<0.4th centile Postural hypotension test fail fractures

Consider further investigations look for signs of eating disorder or differential diagnoses Differential
diagnosis
Full blood count Urea and electrolytes
Alternative explanations
Anaemia Thrombocytopaenia Hyponatraemia Hypokalaemia for weight loss include:
Neutropaenia If significant Dehydration Electrolyte disturbance
Diabetes Coeliac disease
Bone profile ESR* ECG† Hyperthyroidism
Hypophosphataemia Possible organic cause Cardiac arrhythmia
Malignancies
Low calcium, magnesium, or phosphate Bacterial infection Prolonged QTc >450 ms
Eating disorders are associated
Blood glucose Thyroid function tests Signs of electrolyte disturbance with increased rates of other
mental health disorders, including:
Hypoglycaemia Hyperthyroidism Sinus <50 beats/min
bradycardia Depression Anxiety
Obsessive compulsive disorder
Alcohol misuse/dependence
Management and referral
© 2017 BMJ Publishing group Ltd.
If you think they have an eating disorder, consider referral to a specialist child and adolescent
Disclaimer: This infographic is not a validated clinical decision aid. This
eating disorder team. Most young people with eating disorders can be be treated as outpatients. information is provided without any representations, conditions, or
warranties that it is accurate or up to date. BMJ and its licensors assume no
Signs and symptoms marked with may require emergency treatment. responsibility for any aspect of treatment administered with the aid of this
information. Any reliance placed on this information is strictly at the user's
own risk. For the full disclaimer wording see BMJ's terms and conditions:
* ESR = Erythrocyte Sedimentation Rate † ECG = Electrocardiogram http://www.bmj.com/company/legal-information/

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